Provider Demographics
NPI:1417491150
Name:LENNON, EMILY LOUISE (MS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LOUISE
Last Name:LENNON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 CLASSIC DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5817
Mailing Address - Country:US
Mailing Address - Phone:407-247-3078
Mailing Address - Fax:
Practice Address - Street 1:1601 PARK CENTER DR
Practice Address - Street 2:#7
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5700
Practice Address - Country:US
Practice Address - Phone:407-730-3554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health